Complication Of Angioplasty Research Articles

Percutaneous Aspiration Thrombectomy for Arterial Thromboembolic Occlusion Following Percutaneous Transluminal Angioplasty: Technical Success Rates and Clinical Outcomes.

We aimed to analyze the technical success rate of manual percutaneous aspiration thrombectomy (PAT) in patients with peripheral arterial thromboembolism as a complication of infrainguinal percutaneous transluminal angioplasty (PTA) and we sought to evaluate the 30-day postintervention clinical outcome. We retrospectively identified 29patients (men/women, 18/11; mean age, 74 years) who underwent infrainguinal PAT to treat thromboembolic complications of infrainguinal PTA. Primary and secondary technical successes were defined as residual stenosis of < 50 % of the vessel diameter after PAT alone and PAT with additional PTA, respectively. Clinical outcome parameters (e. g., amputation, need for further intervention) were evaluated during the first 30 days after intervention. The primary and secondary technical success rates were 58.6 % (17/29) and 79.3 % (23/29), respectively. Clinical outcome data were available for 93.1 % (27/29) of patients. No further intervention was required within 30 days in 81.5 % (22/27) of patients. Four patients underwent minor amputations owing to preexisting ulcerations (Rutherford Category 5), and no patients underwent major amputations (Rutherford Category 6). Revascularization of the previously treated vessel segment with PTA was necessary on the first postintervention day in one patient. Manual PAT, with PTA if needed, has a good technical success rate and satisfactory early clinical outcome in patients with iatrogenic thromboembolic complications after infrainguinal PTA. · Manual PAT is a possible first-choice treatment of infrainguinal PTA-induced acute thromboembolism.. · Performing additional PTA increases the success rate of manual PAT.. · Unlike catheter-directed intraarterial lysis, manual PAT carries no risk of bleeding.. · Schicho A, Bäumler W, Verloh N et al. Percutaneous Aspiration Thrombectomy for Arterial Thromboembolic Occlusion Following Percutaneous Transluminal Angioplasty: Technical Success Rates and Clinical Outcomes. Fortschr Röntgenstr 2022; 194: 291 - 295.

Complications of balloon pulmonary angioplasty for chronic thromboembolic pulmonary disease according to the classification proposed by the 6th world symposium on pulmonary hypertension

Abstract Introduction Balloon pulmonary angioplasty (BPA) is a complex procedure and not risk free. In an attempt to standardize reports of BPA complications in the several centers, a classification of complications was proposed by the task force on chronic thromboembolic hypertension (CTEPH) in the 6th World Symposium on Pulmonary Hypertension (WSPH). Purpose To determine the prevalence of BPA complications according to the classification of 6th WSPH and to identify its predictors. Methods Detailed procedural and technical aspects were collected for consecutive patients (pts) with inoperable, residual/recurrent chronic thromboembolic disease, undergoing BPA at a single institution from December/2017 to December/2020. Per procedure logistic regression analysis was used to evaluate the predictive variables for complications. Results A total of 76 BPA sessions in 15 pts were performed (mean age 63.2±14.0 years; 60.0% women; 86.7% CTEPH). Mean pulmonary artery pressure and pulmonary vascular resistance before the first BPA session were 33.1±13.3 mmHg and 4.8±3.2 woods unit, respectively (73.3% of pts under vasodilator therapy). Femoral access was used for all pts. Mean vessels treated per procedure were 4.3±1.9 (324 vessels in total). Webs, subtotal occlusions, ring-like stenosis and total occlusions were noted in 215 (66.4%), 58 (17.9%), 31 (9.6%) and 20 (6.2%) treated vessels, respectively. We performed 21 pressure-wire-guided sessions (27.6%). Intravascular imaging was used in 6 procedures (7.9%). Average time of fluoroscopy was 60.3±14.0 minutes and volume of contrast 273.0±73.0 mL per session. Procedure-related adverse events occurred in 25.0% of the interventions (27.6% in the first two years vs 16.7% in the last two). Pulmonary artery vascular injuries were noted in 6 BPA vessels (7.9% per procedure and 1.9% per treated vessel): haemoptysis in all, but perforation was only detected angiographically in 3 of them (balloon inflation was performed for 2 distal perforations, and 1 perforation sealed without any intervention). Vascular dissection in distal lesions occurred in 4 cases (5.3%) with no need of transcatheter or surgical procedures. We had 3 lung injuries, all grade 2. None of the pts required oral intubation or mechanical ventilation. Extra-pulmonary complications were illustrated in table. Importantly, there was no peri-procedural death. The occurrence of vascular or lung injuries was 0% in pressure-wire-guided BPA versus 14.5% in non-guided (p=0.098). Multivariate analysis revealed that age (OR 1.05; CI 1.01–1.10; p=0.030) was the only independent predictor of complications. Conclusions In our experience, BPA can be safely performed in inoperable, residual or recurrent CTEPH or CTED pts, with 25% minor procedural-related complications but no major adverse event. Age was the strongest factor related to the occurrence of complications. Funding Acknowledgement Type of funding sources: None.

Patient after extensive crushing injury of the lower limb with subacute stent thrombosis

Percutaneous transluminal coronary angioplasty with stent implantation is a basic life-saving treatment of stenotic lesions causing acute coronary syndromes. Stent thrombosis is one of the most serious complications of coronary angioplasty, strongly associated with recurrent myocardial infarction and high mortality. Many factors were identified as increasing the incidence of stent thrombosis including bleeding and inflammation. I am presenting a case of a 54-year-old man after extensive crushing injury of the lower limb with simultaneous stent thrombosis in two recently implanted stents. As a preventive measure for stent thrombosis novel potent antiplatelet agents may be a reasonable choice even for patients with high bleeding risk.

Oxygen inhalation can selectively dilate pulmonary arteries in patients with chronic thromboembolic pulmonary hypertension before balloon angioplasty

BackgroundPulmonary injury is a major complication of balloon pulmonary angioplasty (BPA) for chronic thromboembolic pulmonary hypertension (CTEPH). Lung injury after BPA can be exacerbated by a high mean pulmonary arterial pressure (PAP). Although oxygen inhalation is expected to lower mean PAP in patients with CTEPH, no relevant investigation has been conducted. MethodsConsecutive patients with CTEPH who underwent BPA were enrolled in this study. We evaluated the hemodynamics using right heart catheterization while breathing ambient air and with administration of 5 L/min oxygen for 10 min. ResultsThis study included 52 consecutive patients with CTEPH, of whom 23 (44%) were treated with specific pulmonary vasodilators. Exposure to oxygen was well tolerated. Oxygen administration significantly decreased mean PAP by 3.8 ± 3.2 mmHg (p<0.001) and pulmonary vascular resistance by 0.8 ± 1.8 Wood units (p<0.001). Moreover, the ratio of pulmonary vascular resistance to systemic vascular resistance was significantly reduced by 13.5% (p<0.001). Multivariate regression analysis identified baseline mean PAP (β = -0.427, p = 0.006) as the only significant predictor of decreased mean PAP under oxygen administration. No significant difference in oxygen effect on mean PAP was found between patients with and without vasodilators. ConclusionsIn patients with CTEPH, 5 L/min supplemental oxygen inhalation could decrease mean PAP significantly by selective pulmonary artery dilatation, regardless of the usage of vasodilators, and thus could be helpful to maximize the safety of BPA. Clinical trial registrationUMIN Clinical Trials Registry (No.: UMIN000026882); URL: https://www.umin.ac.jp/ctr/index.htm.

MO448MICRORNAS IMPLICATED IN CHRONIC KIDNEY DISEASE

Abstract Background and Aims The gene program is controlled at the post-transcriptional level by the action of small non-coding RNAs known as microRNAs (miRNAs), short, single-stranded molecules that control mRNA stability or translational repression via base pairing with regions in the 3' untranslated region of their target mRNAs. Recently, considerable progress has been made to elucidate the roles of miRNAs in vascular pathogenesis and develop the use of miRNAs as biomarkers, and innovative drugs. We demonstrated during the last decade that miRNAs miR-126 and miR-223 are implicated in the course of chronic kidney disease (CKD) and cardiovascular damage. miR-223 expression is enhanced in vascular smooth muscle cells (VSMCs) subjected to an uremic toxin and also in aortas of a murine model of CKD. As restenosis is a common complication of angioplasty, in which neointimal hyperplasia results from migration of VSMCs into the vessel lumen we measured the effect of miR-223 modulation on restenosis in a rat model of carotid artery after balloon injury. We over-expressed and inhibited miR-223 expression using adenoviral vectors, coding a pre-miR-223 sequence or a sponge sequence, used to trap endogenous microRNA, respectively. We demonstrated that inhibiting miR-223 function significantly reduced neointimal hyperplasia by almost half in carotids. Thus down-regulating miR-223 could be a potential therapeutic approach to prevent restenosis after angioplasty. We also correlated miR-126 and miR-223 expression with clinical outcomes in a large cohort of CKD patients, in collaboration with the University Hospital of Ghent (Belgium) and Ambroise Paré Hospital, France. We evaluated both miRNA’s link with all-cause mortality and cardiovascular and renal events over a 6-year follow-up period. The serum levels of miR-126 and miR-223 were decreased as CKD stage advanced, and patients with higher levels of miR-126 and miR-223 had a higher survival rate. Similar results were observed for cardiovascular and renal events. In conclusion, CKD is associated with a decrease in circulating miR-126 and miR-223 levels in CKD patients. We will also present links between several uremic toxin concentrations and miRNA concentration in the patients of this cohort. Finally, anemia is a common feature of CKD that is associated with cardiovascular disease and poor clinical outcomes. A mixture of uremic toxins accumulates in the blood of CKD patients during the course of the disease, and there is good evidence that they modulate erythropoiesis, explaining at least partly anemia. The exact molecular mechanisms implicated are however poorly understood, although recent progresses have been made to identify key components in the CKD process. We will present results on the effect of uremic toxins on erythropoiesis, having an impact on cell metabolism during this process. Taken together, our findings could be of interest to both researchers and clinicians working in the field since they might shed new light on the molecular mechanisms involved in the CKD process. MicroRNAs implicated in Chronic Kidney Disease Pr. Laurent Metzinger, UR-UPJV 4666 HEMATIM, CURS, Université de Picardie Jules Verne, CHU Amiens Sud, Avenue René Laënnec, Salouel, F-80054, Amiens, France. Tel: (+33) 22 82 53 56, Email: laurent.metzinger@u-picardie.fr

Sphygmomanometer-induced hemostasis following iatrogenic guidewire perforation during lower extremity angioplasty.

Iatrogenic guidewire perforation is a well-known complication of lower extremity angioplasty that is often benign or can be easily treated with endovascular techniques. However, perforations that occur in arterial side branches may be more challenging to manage. If bleeding persists, open surgery and fasciotomy may be required to evacuate the resulting hematoma and prevent compartment syndrome. These subsequent procedures increase morbidity and, if the angioplasty was performed in the outpatient setting, necessitate patient transfer to a hospital. To address these challenges, we describe a non-invasive hemostasis technique involving serial sphygmomanometer cuff inflations over the affected site in a series of five patients who experienced this complication at our office. We retrospectively reviewed the medical records of consecutive patients undergoing lower extremity angioplasty that were found to have an arterial guidewire perforation on completion angiogram at our outpatient center between February 2012 and February 2017. Patients found to have iatrogenic guidewire perforations were administered intravenous protamine sulfate and were transferred to the surgical recovery room. Patients received ibuprofen or acetaminophen for pain management. A blood pressure cuff was placed around the site of perforation, and patients received serial cuff inflation cycles with repeated examinations of both limbs until patients reported cessation of pain and there were no signs of a developing hematoma. Patients were observed for two hours before they were discharged home. A follow-up duplex ultrasound examination was completed within one week of the intervention. Over the course of five years, 536 angioplasties were performed at our outpatient office. Five of these patients experienced iatrogenic guidewire perforation (0.93%). Perforations occurred in branches of the anterior or posterior tibial artery. All of these patients were successfully managed with the aforementioned hemostasis technique. None of these patients required transfer to a hospital for further management, and no complications were reported at follow-up. Complications of iatrogenic guidewire perforations in lower extremity arterial side branches can be safely and effectively managed by applying external compression around the affected site with an automatic blood pressure cuff.

Impact of CADILLAC and GRACE risk scores on short- and long-term clinical outcomes in patients with acute myocardial infarction

BackgroundRecent guidelines recommend risk stratification using objective scoring systems in patients with acute coronary syndrome. In this context, the CADILLAC (Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications) and GRACE (Global Registry of Acute Coronary Events) risk scores were both originally established to predict short-term mortality. However, their impact on short- and long-term clinical outcomes in a contemporary cohort of patients with acute myocardial infarction (MI) is unclear. MethodsThis bi-center registry included 809 patients with acute MI undergoing primary percutaneous coronary intervention. Patients were divided into three groups according to the pre-defined thresholds and tertiles of the CADILLAC and GRACE scores. The study endpoints included all-cause death and major adverse cardiovascular events (MACE) during the index hospitalization and after discharge. ResultsOf 809 patients, 323 (39.9%) and 255 (31.5%) had high CADILLAC and GRACE risk scores. During the index hospitalization, 61 (7.5%) patients died and 262 (32.4%) had MACE. Both CADILLAC and GRACE risk scores were associated with in-hospital mortality and MACE rates. After discharge, out of 683 patients with available follow-up information who survived to discharge, 42 (6.1%) died and 123 (18.0%) had MACE during the median follow-up period of 632 days. Significantly higher incidence of MACE in higher CADILLAC and GRACE risk scores was observed in a stepwise manner. ConclusionBoth CADILLAC and GRACE risk scores were predictive for short- and long-term mortality and MACE rates in a contemporary cohort of acute MI patients undergoing primary percutaneous coronary intervention.

Radial Aneurysmal AV Fistula as a Complication of Coronary Angioplasty.

Radial Aneurysmal AV Fistula as a Complication of Coronary Angioplasty.

Continual Improvement in Pressure Gradient at the Lesion After Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension

BackgroundLung injury is a serious complication of balloon pulmonary angioplasty (BPA) for chronic thromboembolic pulmonary hypertension (CTEPH). Selecting a smaller balloon might minimize the occurrence of lung injury; however, it could also increase the risk of restenosis. MethodsWe analyzed the first target lesions in the initial BPA procedure in 34 consecutive patients with CTEPH. We measured proximal pressure with a guiding catheter and distal pressure with a pressure wire. We retrospectively investigated pressure gradients at the lesions before and immediately after the initial dilation with a smaller balloon and before the second procedure. ResultsThe proximal pressure decreased, and the distal pressure increased immediately after the initial balloon dilation. The pressure gradient at the lesion diminished significantly by the second procedure (from 26.4 ± 10.7 to 18.2 ± 9.9 mm Hg, P < 0.001) without serious complications. The residual pressure gradient had further diminished (to 9.8 ± 6.5 mm Hg, P = 0.02) until the second procedure. The reduction in pressure gradient at the lesion from immediately after the initial balloon dilation to the second procedure was positively correlated with both the baseline mean pulmonary arterial pressure (r2 = 0.23, P = 0.004) and residual pressure gradient immediately after the initial balloon dilation (r2 = 0.58, P < 0.001). ConclusionsThe residual pressure gradient at the lesion diminished continually after dilation with a smaller balloon. This strategy could decrease pulmonary arterial pressure safely. It would be reasonable to dilate the lesions sequentially in 2 procedures.

Angioplasty and stenting for symptomatic stenosis of the left subclavian artery complicated with aortic dissection.

Aortic dissection is a rare but severe complication of percutaneous transluminal angioplasty and stenting (PTAS) for stenosis of the subclavian artery (SA). This retrospective study was designed to evaluate the risk factors and outcomes of patients with severe stenosis of the SA who underwent PTAS complicated by aortic dissection. Between 1999 and 2018, 169 cases of severe symptomatic stenosis of the SA underwent PTAS at our institute. Of them, six cases complicated by aortic dissection were included in this study. We evaluated the demographic features, technical factors of PTAS, and clinical outcomes in these six patients. Aortic dissection occurred in 5.3% (6/113) of all left SA stenting cases but in none of the right SA stenting cases. All patients had hypertension and a high severity of SA stenosis (85.0 ± 13.0%, 60%-95%). Five of the six patients received balloon-expandable stents (83.3%). All patients had spontaneous resolution of the aortic dissection with conservative treatment. In a 63.33 ± 33.07 (7-118) month follow-up, five of the six patients (83.3%) had long-term symptom relief and stent patency. Aortic dissection occurred in patients who underwent PTAS for severe stenosis of the left SA, mainly with balloon-expandable stents. We suggest using self-expandable stents and angioplasty with an undersized balloon during PTAS for severe stenosis of the left proximal SA to prevent aortic dissection.

The Association between Co-Administration of Omeprazole and Clopidogrel and Cardiovascular Outcomes

Objective: To examine whether co-administration of clopidogrel and omeprazole affects the clinical outcomes of clopidogrel treatment. Design and Methods: A retrospective cross-sectional study of 4078 patients after a percutaneous coronary intervention and stent implantation. Seven hundred twenty-three clopidogrel-treated patients who fulfilled the inclusion criteria of the study were included: 318 treated only with clopidogrel; 405 treated with clopidogrel and omeprazole (study group). The interaction between the drugs was examined in relation to adverse clinical outcomes such as all-cause mortality, Major Adverse Cardiovascular Events (MACE) and cardiac hospitalizations during one year. Results: No significant difference was detected between the groups regarding the primary outcomes of the study. Regression models adjusted to basic characteristics and clinical variables showed a significant association between the study group and the primary outcomes through interactions with specific covariates: “all-cause mortality” through interaction with the covariate ethnicity (not-Jewish) (OR = 43.12, 95% CI 1.19-1567.8, P = 0.04), “MACE” through interaction with the covariates gender (female) and complicated angioplasty (OR= 9.36, 95% CI 2.04-42.94, P= 0.04); and “cardiac hospitalizations” through interaction with the covariates extent of artery stenosis and hypertension (OR= 2.65, 95% CI 1.043-6.76, P = 0.04). Conclusion: Addition of omeprazole to clopidogrel may be associated with increased incidence of negative clinical outcomes, including death and MACE. These findings underscore the need for conduction of prospective randomized controlled trials that will examine the association between addition of omeprazole to clopidogrel and the incidence of clinical outcomes.

Predictive Power of In-Hospital and Long-Term Mortality of the GRACE, TIMI, Revised CADILLAC and PAMI Score in NSTEMI Patients with Diabetes - Data from TSOC ACS-DM Registry.

Risk score is widely used in non-ST segment elevation myocardial infarction (NSTEMI) patients to predict the in-hospital outcome for immediate coronary angiography decision and care of unit selection. This study compared the performances of the thrombolysis in myocardial infarction (TIMI), Global Registry of Acute Coronary Events (GRACE), Primary Angioplasty in Myocardial Infarction (PAMI), and Revised Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (Revised CADILLAC) risk scores in predicting in-hospital and long-term outcomes in diabetic NSTEMI patients. A total of 750 diabetic NSTEMI patients from 27 hospitals were enrolled between January 2013 and December 2015 in the nationwide registry initiated by the Taiwan Society of Cardiology. Four score systems were calculated with receiver operator characteristic analysis used to compare outcome discrimination performance. No studied risk scores reached acceptable discrimination per area under curve (AUC) in the prediction of in-hospital outcome except for the revised CADILLAC score which reached acceptable discrimination in new-onset cardiogenic shock (AUC = 0.7191) and acute renal failure (AUC = 0.7283). In long-term outcomes, only the revised CADILLAC score reached acceptable discrimination of mortality prediction at 6, 12 and 24 months (AUC = 0.7261 at 6 months, 0.7319 at 12 months, and 0.7256 at 24 months). Subgroup analysis based on the revised CADILLAC score risk class showed a significant difference in adjusted mortality rate between low-risk group/intermediate-risk group and high-risk group. Only the revised CADILLAC score showed acceptable accuracy to predict the long-term mortality outcome among the scores studied.

TCT CONNECT-52 Angiographic Complications in Primary Angioplasty: Influence of Age (Analysis From 2,121 Consecutive Patients)

TCT CONNECT-52 Angiographic Complications in Primary Angioplasty: Influence of Age (Analysis From 2,121 Consecutive Patients)

Inhibition of miR-223 Expression Using a Sponge Strategy Decreases Restenosis in Rat Injured Carotids.

Restenosis is a frequent complication of angioplasty. It consists of a neointimal hyperplasia resulting from progression and migration of vascular smooth muscle cells (VSMC) into the vessel lumen. microRNA miR-223 has recently been shown to be involved in cardiovascular diseases including atherosclerosis, vascular calcification and arterial thrombosis. In this study, our aim was to assess the impact of miR-223 modulation on restenosis in a rat model of carotid artery after balloon injury. The over and down-expression of miR-223 was induced by adenoviral vectors, containing either a pre-miR-223 sequence allowing artificial miR-223 expression or a sponge sequence, trapping the native microRNA, respectively. Restenosis was quantified on stained rat carotid sections. In vitro, three mRNA (Myocyte Enhancer Factor 2C (MEF2C), Ras homolog gene family, member B (RhoB) and Nuclear factor 1 A-type (NFIA)) reported as miR-223 direct targets and known to be implicated in VSMC differentiation and contractility were studied by RT-qPCR. Our findings showed that down-expression of miR-223 significantly reduced neointimal hyperplasia by 44% in carotids, and was associated with a 2-3-fold overexpression of MEF2C, RhoB and NFIA in a murine monocyte macrophage cell line, RAW 264.7 cells. Down-regulating miR-223 could be a potential therapeutic approach to prevent restenosis after angioplasty.

Bailout procedures during percutaneous transluminal angioplasty of superficial femoral artery occlusive disease

BackgroundThough uncommon, complications of endovascular angioplasty and stenting may have devastating outcomes that can threaten limb and life. Adequate awareness of these complications will allow to achieve excellent clinical outcomes.ResultsEndovascular intervention was successful in treatment of most of distal SFA complications with limited use in flush ostial complications; residual stenosis ≥ 30%, flow-limiting dissection, perforation or rupture; 100% in group (2) vs 50% in group (1) but thrombosis; 75% of distal SFA lesions were treated endovascularly vs 40% of flush ostial lesions; X2 = 12.7, P = 0.02. Emergency surgery as a bailout was used for most ostial lesion complications: residual stenosis ≥ 30%, flow-limiting dissection, and perforation or rupture; 50% in group (1) vs 0% in group (2); X2 = 20.1, P = 0.01.ConclusionBailout procedures are procedures used to save the limb or the patient. Evolving endovascular strategies embrace new technologies in an attempt to improve the safety and efficacy of revascularization procedures for lower extremity arterial occlusive disease.

Сосудистые осложнения при чрескожной транслюминальной коронарной ангиопластике, связанные с трансрадиальным доступом, и их профилактика

Сосудистые осложнения при чрескожной транслюминальной коронарной ангиопластике, связанные с трансрадиальным доступом, и их профилактика

Endovascular management of transplant renal artery stenosis: A single-center retrospective study.

The aim is to evaluate the efficacy and complications of percutaneous transluminal angioplasty (PTA)/stenting in the treatment of transplant renal artery stenosis (TRAS). TRAS is a relatively rare condition, and currently, there is not enough study about interventional therapy for TRAS. Between April 2011 and July 2018, 33 patients with TRAS underwent interventional therapy. Analysis of parameters was as follows: technical success, pretreatment and posttreatment serum creatinine, and blood pressure, and vessel patency via ultrasound at 1, 6, and 12 months posttreatment and once a year thereafter. One procedure failed. The success rate of PTA/stenting placement was 97.0%. Fourteen PTAs with 16 stents were primary interventions, with 2 stent procedures performed subsequently due to restenosis; the restenosis rate was 6.3%. During the follow-up period, two patients progressed to graft renal failure and three patients were lost to follow-up. The rest of the patients still had stable graft function and blood pressure. Compared with preoperative conditions, blood pressure and serum creatinine significantly decreased (p < .05). No treatment-related deaths or serious complications occurred. PTA/stenting is a safe and effective treatment for TRAS. For selected TRAS patients, PTA or PTA with stent may achieve good therapeutic outcomes. Selecting appropriate puncture pathways may help improve the success rate and affect the operation results, and open surgery may be avoided.

P845Comparison of the performance of the five validated risk scores in acute myocardial infarction patients undergoing primary PCI

Abstract Background Several risk scores have been developed to predict mortality of patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (pPCI), with limited data on the comparative prognostic value of these models. Purpose We aimed to compare the prognostic value of five validated risk scores for in-hospital and one-year mortality of patients with AMI undergoing pPCI. ume catheterization laboratory in a period from January 2009 to December 2017, a total of 3868 consecutive patients who underwent pPCI were available for analysis. For each patient, the Thrombolysis In Myocardial Infarction (TIMI), Controlled Abciximab and Device Investigation to Lower Late Angioplasty complications (CADILLAC), ACTION Registry-GWTG in-hospital mortality risk score (ACTION), Age, Creatinine, and Ejection Fraction (ACEF), and ZWOLLE risk scores were calculated using required clinical and angiographic characteristics. In-hospital and one-year mortality were assessed (follow-up available for 92% of pts). Calibration and discrimination of the three risk models were evaluated by the Hosmer-Lemeshow (H-L) goodness-of-fit test and C-statistic, respectively. Results Mortality rates for in-hospital and one-year mortality were 1.8% and 6.9% respectively. All five scores showed good model calibration as assessed by the H-L test and very good discriminative power for in-hospital and one-year mortality as assessed by C-statistics (Table 1 &amp; Figure 1): Table 1 Risk score H-L H-L p AUC in-hospital 95% CI Significant p AUC one-year 95% CI Significant p ZWOLLE 1.3 0.7 0.90 0.89–0.91 vs. CADILLAC &lt;0.05 0.75 0.74–0.77 vs. TIMI &lt;0.005 ACTION 13.1 0.1 0.87 0.86–0.88 vs. TIMI &lt;0.005 0.79 0.77–0.80 CADILLAC 5.5 0.2 0.85 0.84–0.86 vs. TIMI &lt;0.01 0.81 0.80–0.83 vs. ZWOLLE &lt;0.000 vs. TIMI &lt;0.000 ACEF 9.9 0.3 0.814 0.83–0.85 0.80 0.78–0.81 vs. ZWOLLE &lt;0.000 vs. TIMI &lt;0.05 TIMI 7.1 0.3 0.79 0.78–0.80 0.76 0.75–0.78 Figure 1 Conclusion Risk stratification of patients with AMI undergoing pPCI using the ZWOLLE, ACTION, CADILLAC, ACEF or TIMI risk scores enables accurate identification of high-risk patients for in-hospital and one-year mortality in an all-comers population. Among evaluated scores, ZWOLLE model was better fitted for prediction of in-hospital mortality while CADILLAC and ACEF better predicted late events.

A patient-specific numerical modeling of the spontaneous coronary artery dissection in relation to atherosclerosis

The spontaneous coronary artery dissection (SCAD) is a clinical complication of angioplasty leading to an initiation of a tear/crack in the intima layer of the artery. The crack can propagate to the interface of the intima-media layer following by intramural hematoma. The relation between the SCAD and atherosclerosis is a controversial issue, as some studies stated no correlation between them while others showed that a crack can initiate in the intima but cannot propagate into the atrophied media layer. To investigate the relation between the intraluminal crack propagation in the atherosclerotic artery and SCAD, this study numerically investigated the initiation and propagation of a crack in the intraluminal and radial locations of the healthy and atherosclerotic human coronary arterial walls. The energy release rate, namely J-integral, is computed as a numerical derivative of the strain energy with respect to a crack extension using a user-defined virtual crack method (VCE) of extended finite element method (XFEM). Experimental measurements were carried out to calculate the elasto-plastic mechanical properties of the healthy and atherosclerotic human coronary arteries. The experimental data were then assigned to our own established patient-specific FE model of the coronary artery. Cracks were sketched in the intraluminal and radial locations of the arterial wall and allowed to propagate to the virtual interface of the intima-media to form a false lumen. The results revealed a higher stress at the crack tip of the healthy arterial wall compared to the atherosclerotic one. Lower crack tip opening displacement (CTOD) and crack tip opening angle (CTOA) were observed in the intraluminal crack of the atherosclerotic artery. J-integral of the atherosclerotic arterial wall was also found to be higher than the healthy one at the intraluminal crack. The results revealed that although a crack can initiate in the intraluminal of an atherosclerotic artery, it cannot propagate into the media layer due to a relatively higher rate of the strain energy release in the atherosclerotic arterial wall compared to the healthy one.

Sentinel Angiographic Signs of Cerebral Hyperperfusion after Angioplasty and Stenting of Intracranial Atherosclerotic Stenosis: A Technical Note.

Cerebral hyperperfusion syndrome is a serious complication of endovascular angioplasty and stent placement for long-standing intracranial stenosis, resulting in neurologic dysfunction, seizure, or reperfusion hemorrhage. Rigorous control of blood pressure is commonly used in the perioperative period to prevent cerebral hyperperfusion syndrome, but the optimal blood pressure is often arbitrary. We describe the angiographic features that reflect impaired cerebral autoregulation and microvascular transit abnormality, which may be used to gauge the optimal blood pressure parameters in the immediate postintervention period for prevention of cerebral hyperperfusion syndrome.